Return by April 1, 2009.....................No Late Entries Accepted........................................... No.______

Kansas State Science and Engineering Fair
Friends University
Wichita, Kansas

NAME OF EXHIBITOR ______________________________________GRADE ______AGE______
........................................(Last)..............PLEASE PRINT............ (First)

ADDRESS (Home)____________________________________________________________________

CITY __________________________________ ZIP_____________ PHONE ____________________

TITLE OF EXHIBIT __________________________________________________________________

T-SHIRT SIZE ________

Place a check in the blanks: DIVISION: [ ] Division I (9-12) [ ] Division II (4-8)

AREA: [ ] Botany [ ] Zoology [ ] Earth/Space Science

[ ] Physics [ ] Chemistry [ ] Biochemisty, Medicine & Health

[ ] Mathematics & Computer Science [ ] Environmental Science

[ ] Social Science/Behaviorial [ ] Consumer Science [ ] Engineering

NAME OF SCHOOL __________________________________________________________________

ADDRESS OF SCHOOL _______________________________________________________________
..........................................(Street).......................................(City)........................... (Zip)

PRINCIPAL’S NAME _____________________________ SCHOOL PHONE# ____________________

TEACHER’S NAME _________________________ TEACHER’S EMAIL _______________________

TEACHER'S ADDRESS ______________________________________________________________

Please attach a brief description of your project (typed or printed) on the back of this application. This MUST BE FILLED OUT or the project will be disqualified.

PARENTAL APPROVAL: I certify that to the best of my knowledge, this exhibit was essentially completed by and is largely the work of the student named above, and I give my approval for its showing at the Kansas Science and Engineering Fair. I also understand that NO project can be removed until after the awards ceremony. NO EXCEPTIONS. I have seen and read the rules for the fair. (Get a copy of rules from your teacher.)

_________________________________________
(Parent’s Signature) MUST be signed by parent only.

Make sure all sections of this form are completed. It is very important.

Mail to K. Ring, EJSHS, 814 N. Jefferson, Eureka, KS 67045 or Fax to 620-583-8222.

KSEF PROJECT

Project Title: _________________________________________________________________________

Question (Why did you conduct the experiment? What did you hope to learn?)

Hypothesis (What did you think would happen?)

Procedures
Materials Needed:

Step-By-Step Directions:

AUTHORIZATION TO PHOTOGRAPH, VIDEOTAPE OR RECORD STUDENT

The student and student’s parent or guardian hereby authorizes, releases and/or otherwise consents to the student being the subject or photographs, videotapes or audio tapes, or combinations thereof, that are taken, shot or recorded at Kansas State Science & Engineering Fair (KSSEF) related activities.

KSSEF and/or any of its volunteers, sponsors or agents is specifically given the right and permission to cause the student’s likeness or voice or both to be recorded and exhibited as still photographs, transparencies, motion pictures, television, video (videotape recordings) or other similar media, including internet applications.

KSSEF and/or any of its volunteers, sponsors or agents is specifically given the right and permission to distribute, copyright and/or use, reuse and/or broadcast, rebroadcast, publish and republish still photographs, transparencies, motion pictures, television, video (videotape recordings) or other similar media, including internet applications.

The student waives the right to inspect or approve the finished still photograph, transparencies, motion pictures, television, video (videotape recordings) or other similar media including any sound track associated therewith, or advertising copy or printed matter that may be used in conjunction therewith or the eventual use that may be mad of such still photograph, transparencies, motion pictures, television, video (video recordings) or similar media, including internet applications.

The student specifically authorizes the reproduction, sale, exhibition, broadcast and/or distribution of this material without limitation.

Student’s _________________________ Parent’s or Legal Guardian’s ___________________________
...............Signature..................................................................................Signature

Date: ______________________________ Date: ____________________________________

I do not give permission for my student’s information to be released

THIS FORM MUST BE SIGNED AND SUBMITTED WITH THE ENTRY FORM.